Polylysine Enriched Matrices: A Promising Approach for Vascular Grafts

Cardiovascular diseases represent the leading cause of death in developed countries. Modern surgical methods show poor efficiency in the substitution of small-diameter arteries (<6 mm). Due to the difference in mechanical properties between the native artery and the substitute, the behavior of the vessel wall is a major cause of inefficient substitutions. The use of decellularized scaffolds has shown optimal prospects in different applications for regenerative medicine. The purpose of this work was to obtain polylysine-enriched vascular substitutes, derived from decellularized porcine femoral and carotid arteries. Polylysine acts as a matrix cross-linker, increasing the mechanical resistance of the scaffold with respect to decellularized vessels, without altering the native biocompatibility and hemocompatibility properties. The biological characterization showed an excellent biocompatibility, while mechanical tests displayed that the Young’s modulus of the polylysine-enriched matrix was comparable to native vessel. Burst pressure test demonstrated strengthening of the polylysine-enriched matrix, which can resist to higher pressures with respect to native vessel. Mechanical analyses also show that polylysine-enriched vessels presented minimal degradation compared to native. Concerning hemocompatibility, the performed analyses show that polylysine-enriched matrices increase coagulation time, with respect to commercial Dacron vascular substitutes. Based on these findings, polylysine-enriched decellularized vessels resulted in a promising approach for vascular substitution

Istituzioni locali, performance, trasparenza. Il controllo di gestione in Italia e nel Regno Unito

Nel corso degli ultimi due decenni le riforme amministrative hanno promosso negli enti locali l’introduzione del controllo di gestione con l’obiettivo di accrescerne efficienza, efficacia e qualità delle prestazioni fornite a cittadini e imprese in un contesto di rigido controllo della spesa pubblica. Già dall’inizio degli anni ottanta comuni e province sono stati i laboratori in cui le amministrazioni pubbliche hanno iniziato a sperimentare il controllo di gestione perché, in quanto istituzioni più a contatto con cittadini e imprese, per prime hanno avvertito la necessità di incrementare le proprie performance. La riforma Cassese, in parte anticipata per gli enti locali dalla legge n. 142/1990, ha rappresentato un punto di svolta rispetto ai sistemi di controllo, e la riforma Bassanini del 1999 ha quindi cercato di renderli conformi a un’amministrazione «pluralista», accrescendone il livello di articolazione funzionale e organizzativa. Tuttavia, come evidenzia la ricerca i cui risultati vengono presentati in questo volume, nella maggioranza degli enti locali lo sviluppo di strumenti e pratiche manageriali è ancora nullo o carente, il sistema di controllo interno, anche laddove è stato impiantato e ha attecchito, fatica a produrre report e, comunque, le informazioni generate sono poi raramente utilizzate per operare scelte gestionali. Le ragioni di questo (parziale) insuccesso sono diverse e soprattutto riconducibili al fatto che si è preferito, sotto l’incalzare delle difficoltà della finanza pubblica, introdurre meccanismi di contenimento della spesa piuttosto che la sua riqualificazione. È quindi evidente che la riforma dei controlli rischia, ancora una volta, di produrre solo un limitato adempimento dei precetti normativi, ma non un effettivo miglioramento del modo di gestire le amministrazioni locali, ed è probabile che i tagli imposti ai fondi in materia di formazione e di consulenza rappresenteranno un impedimento notevole all’attuazione della riforma. In questa situazione l’unica alternativa praticabile sembra essere quella di valorizzare al massimo i giacimenti di conoscenze e capacità di cui le amministrazioni pubbliche già dispongono al proprio interno, a partire da quelle dei network che legano tra loro le persone che lavorano negli enti locali

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially